Redo aortic valve surgery: Influence of prosthetic valve endocarditis on outcomes

Abstract

Despite contemporary therapy, reoperation for aortic prosthetic valve endocarditis is still associated with relatively high perioperative mortality and limited long-term survival.

The Year in Review: The Surgical Treatment of Valvular Disease-2011

“…Nevertheless, this remains a high‐risk group with significant morbidity and mortality, especially in those patients with prosthetic valve endocarditis. Similar findings were noted by Leontyeu et al in a study that compared short‐ and long‐term outcomes following reoperative valve replacement for endocarditis 70 . In this series of 313 patients requiring reoperative AVR, 152 patients (48.6%) had prosthetic valve endocarditis.…”

Short- and long-term outcomes following redo valvular surgery

“…The mortality rate following redo valvular surgery ranges from 7% to 11% . We analyzed post‐operative outcomes based on surgical techniques applied in redo surgery.…”

“…Risk factors for in‐hospital death in this series were NYHA class III/IV and hemodialysis. Other reported factors include sex, major cardiovascular injury during re‐entry, concomitant coronary artery bypass grafting, advanced age, decreased left ventricular function, endocarditis, replacement of a mechanical valve, advanced NYHA class, emergency surgery, chronic obstructive pulmonary disease, renal failure, and peripheral vascular disease . Early referral in older patients with NYHA class I/II may help to decrease hospital mortality in these higher risk patients .…”

Prosthetic valve endocarditis: state of the heart

“…As compared with NVE, surgical intervention for PVE has been found to have higher rates of 30-day mortality (13 vs 5.6%) but long-term survival does not appear to be significantly different [78]. Also, redo aortic valve surgery for PVE has been shown to be associated with significantly higher in-hospital mortality as well as higher 1-, 3-, 5-and 10-year mortality as compared with redo aortic valve surgery for non-endocarditic causes [79]. In this group of patients, 5-year actuarial freedom from endocarditis was only 80% in patients who underwent redo surgery for PVE as compared with 95% in patients who underwent redo surgery for non-endocarditic causes.…”